NPIMap

Organization Active NPI

Vineville Internal Medicine LLC

  • Internal Medicine Physician
  • Macon, GA
National Provider Identifier
1396955431
Registry record updated Aug 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
049552 Issued in GA
Legal business name
VINEVILLE INTERNAL MEDICINE LLC
Practice address
3448 Vineville Ave
Macon, GA 31204-1867
Phone
(478) 405-0045
Fax
(478) 405-0054
NPI assigned
May 23, 2007
Last updated
Aug 20, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Katie B Andrews
Title
Administration
Phone
(478) 405-0045

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X 049552 GA Primary

Addresses

Primary practice location

3448 Vineville Ave
Macon, GA 31204-1867

Mailing address

3448 Vineville Ave
Macon, GA 31204-1867
Phone (478) 405-0045

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060223000410 GA Part B Supplier - Clinic/Group Practice 0941281711 Receives reassigned benefits from 34 practitioners
Practice locations: Macon, GA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D1005138Vineville Internal Medicine3448 Vineville Avenue, Macon, GA 31204ComplianceDec 11, 2027

National Provider Directory

National Provider Directory

Locations

147 James St
Gray, GA 31032
Phone (478) 405-0045

3448 Vineville Ave
Macon, GA 31204
Phone (478) 405-0045

506 Osigian Blvd
Warner Robins, GA 31088

506 Osigian Blvd
Ste 3
Warner Robins, GA 31088

506 Osigian Blvd
Ste 4
Warner Robins, GA 31088
Phone (478) 405-0045

Practitioners & affiliated clinicians

Practitioners 35

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 35

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408492800000",
    "number": "1396955431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3448 VINEVILLE AVE",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312041867",
            "telephone_number": "478-405-0045",
            "fax_number": "478-405-0054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3448 VINEVILLE AVE",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312041867",
            "telephone_number": "478-405-0045",
            "fax_number": "478-405-0054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VINEVILLE INTERNAL MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2014-08-20",
        "status": "A",
        "authorized_official_last_name": "ANDREWS",
        "authorized_official_first_name": "KATIE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "ADMINISTRATION",
        "authorized_official_telephone_number": "478-405-0045",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "049552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.